POS0970 PSYCHO-COGNITIVE FACTORS AND ADHERENCE IN AXIAL SPONDYLOARTHRITIS: A MULTICENTER CROSS-SECTIONAL STUDY
Authors: M. Vandersmissen, T. Barnetche, A. Charlotte, J. Bernard, D. Jerome, J. Landrin, C. Lukas, A. Ruyssen-Witrand, A. Tournadre, P. Vergne-Salle
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> There is a lack of data on adherence in axial Spondyloarthritis (axSpA). It is estimated between 28.2 et 70.6% by the largest study currently available [1]. Many factors may influence adherence, among them psychological factors. <h3>Objectives</h3> The objectives were to assess the adherence to biological disease-modifying anti-rheumatic drug (bDMARDs) and the impact of catastrophizing, fibromyalgia, anxiety, and depression in a cohort of patients with axSpA. <h3>Methods</h3> A multicenter cross-sectional study was conducted in five departments of Rheumatology in France. Inclusion criteria were axSpA according to the ASAS criteria, and treatment by bDMARDs. Patients completed an anonymous self-questionnaire including demographic data, disease activity scores, Girerd score (GS) measuring adherence, and psycho-cognitive scores such as the Fibromyalgia Rapid Screening Tool (FIRST), Hospital Anxiety and Depression Scale (HAD) and the Pain Catastrophizing Scale (PCS). Rheumatologists completed an independent medical questionnaire collecting the disease-related data. <h3>Results</h3> 500 patients with axSpa were enrolled into the study between June 2021 and June 2022. Patients had a mean age of 49.5 ±13.8 and 53.2% were male. They were treated by anti-TNF, anti-IL 17 or anti-IL 12-23 in 85.8%, 13.2% and 1% of cases, respectively. Forty-nine point two percent were adherent (GS=0) and 50.8% were non-adherent (GS ≥1). The prevalence of catastrophizing, fibromyalgia, anxiety and depression in our study was 17.2%, 21.4%, 25.6% and 11.0%, respectively. Patients with best adherence were older (mean age: 53.26 ± 13.3 with GS=0 vs 45.85 ± 13.4 with GS ≥1; p&lt;0.0001), pensioners (26.4 % with GS=0 vs 12.6% with GS ≥1; p&lt;0.001) and had a lower education level (OR 1.84; 95% CI 1.23-2.75; p=0.03). Patients with anxiety and catastrophizing had a lower adherence (OR 1.53; 95% CI 1.02-2.30; p=0.04 and OR 1.61; 95% CI 1.00-2.58; p=0.05, respectively). Adherence was not different between male and female patients, although female patients with axSpA had more catastrophizing (OR 1.84; 95% CI 1.15-2.95; p=0.015), fibromyalgia (OR 3.27; 95% CI 2.07-5.16; p&lt;0.0001) or anxiety (OR 2.26; 95% CI 1.50-3.41; p&lt;0.0001). In multivariate analysis, lower adherence was associated with younger age (OR 0,96; 95 CI 0,95-0,98; p&lt;0,001) and anxiety (OR 1,72; 95% CI 1,05-2,81; p=0,03). <h3>Conclusion</h3> Half of axSpA patients were non-adherent to bDMARDs, especially among young people, catastrophizers and patients with anxiety. We recommend that practitioners screen for these psycho-cognitive factors and manage them very carefully. <h3>Reference</h3> [1]Smolen JS, Gladman D, McNeil HP, Mease PJ, Sieper J, Hojnik M, et al. Predicting adherence to therapy in rheumatoid arthritis, psoriatic arthritis or ankylosing spondylitis: a large cross-sectional study. RMD Open. 2019 Jan;5(1):e000585. <h3>Acknowledgements</h3> Thanks to the patients for their time and to the authors for their help designing the study and collecting the data. <h3>Disclosure of Interests</h3> Maxime Vandersmissen: None declared, Thomas Barnetche Paid instructor for: Biogen, AMORY Charlotte: None declared, Jessika BERNARD: None declared, DESPRES Jerome: None declared, Justine LANDRIN: None declared, Cédric Lukas Speakers bureau: Abbvie, Amgen, Janssen, Lilly, MSD, Novartis, Pfizer, Roche-Chugai, UCB, Consultant of: Abbvie, Amgen, Janssen, Lilly, MSD, Novartis, Pfizer, Roche-Chugai, UCB, Grant/research support from: Pfizer, Novartis and Roche-Chugai, Adeline Ruyssen-Witrand Speakers bureau: AbbVie, Amgen, Biogen, Bristol Myers Squibb, Fresenius-Kabi, Galapagos, Janssen, Lilly, MSD, Mylan, Nordic-Pharma, Novartis, Pfizer, Roche Chugai, Sanofi, and UCB, Consultant of: AbbVie, Bristol-Myers Squibb, Eli Lilly, Mylan, Novartis, Pfizer Inc, Sanofi Genzyme., Grant/research support from: AbbVie, Amgen, Mylan, Pfizer Inc, Anne Tournadre Speakers bureau: Abbvie, Fresenius, Janssen, MSD, Pfizer, Roche Chugai, Sanofi., Paid instructor for: Fresenius, Consultant of: Abbvie, Fresenius, Lilly, Novartis, Sanofi, Grant/research support from: Fresenius, Novartis, Pfizer, UCB, Pascale Vergne-Salle Speakers bureau: Abbvie, Fresenius, Grünenthal, Janssen, Pfizer, Roche Chugai, Sanofi, Novartis, Mylan, UCB, Lilly, Consultant of: Janssen, Abbvie, UCB.